Evaluating tourniquet use in Swedish prehospital care for civilian extremity trauma

Eric Wellme, Victor Mill, Carl Montán

Eur J Trauma Emerg Surg 2020 Apr 29; Online ahead of print.

Purpose: The use of tourniquet (TQ) is today a well-documented and lifesaving adjunct to control bleeding from extremity trauma in the military setting. Since August 2015, the ambulance services in Stockholm, Sweden are equipped with TQs. The implementation and potential complications related to TQ use have so far not been evaluated. The primary aim of this study was to evaluate the prehospital use of TQ for haemorrhage control in extremity trauma. Possible complications following the use of TQ were analysed.

Methods: A retrospective, descriptive cohort study of extremity haemorrhage for all patients (n= 56) with a documented prehospital use of TQ admitted to the trauma centre at Karolinska University Hospital from 1st August 2015 to 31st December 2017 was conducted. Data regarding TQ use including indication, duration, bleeding volume, complications and definitive injury were analysed.

Results: Out of 63 placements of TQ in 56 patients, TQ stopped the bleeding effectively in 98.2% of the cases and the TQ time varied from 15 to 100 min. The overall complication rate was 30.1%; however, complications possibly related to TQ use were 3.6%. In 16 (28.6%) cases, the TQ were used for a non-life-threating haemorrhage which may have been stopped with direct pressure only.

Conclusion: This study shows TQs to be an effective but overused tool in haemorrhage control. The use of TQ was not associated with any severe complications, implying the safety and effectiveness of the device in the civilian setting if TQ time is kept under 100 min.